Urology Coding Alert

Urologists who treat patients with triple mix have many billing options and often dont know which ones to exercise. By keeping abreast of carrier policies, urologists can receive proper reimbursement for the supply, teaching and injection of this medication.

Triple mix is a solution used by urologists to treat impotence. It consists of three medications: papaverine, phentolamine and alprostadil. When injected into the penis, it produces an erection for sexual intercourse. Used therapeutically, it is self-administered by the patient.

Coding Triple Mix

There are some coding challenges involved in getting paid for treatment with triple mix. First, insurance companies may not cover the medication itself. Scott Radle, business manager for Accent Urology, a two-urologist practice in St. Louis says, You have to first check with the patients insurance carrier and see if it is covered. If it is covered, it is under the pharmacy benefit, and you can bill for it that way. In general, it is easier just to bill the patient directly. We usually collect the money for the vial (of medication) up front from the patient, and then the patient can submit it under his pharmacy benefit.

But regardless of who is paying patient or insurance company you need to code it correctly for your records. The codes for the medication are J2760 (injection, phentolamine mesylate, up to 5 mg), J2440 (injection, papaverine HCL, up to 60 mg) and J0270 (injection, alprostadil, 1.25 mcg [code may be used for Medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered]).

When the patient picks up the vial to take it home, there is not just one dose but 10 doses. Radle recommends billing out 10 units of each for the take-home vials.

For Medicare carriers that allow benefits, the injection and initial titrating dosage for erectile dysfunction must be billed to Medicare, explains Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a compliance, coding and reimbursement consultant based in Denver. After that, payment up front by the patient is suggested, says Page.

There are two basic ways to obtain the triple mix. One is to work with a pharmacist who will mix the combination to suit the urologist. Every urologist seems to prefer his or her own proportions of the three medications in the triple mix. We get it premixed from the pharmacist, Radle explains. Then, when the patient comes in to pick up his medication, there is no billing. The patient simply pays for the drug, and the encounter is complete.

The other method of obtaining the medication is to give the patient a prescription for the three separate drugs. The patient buys it [...]